Government Teams recovered $4.3 Billion in FY 2013 and $19.2 billion over the last five years

The new annual Health Care Fraud and Abuse Control (HCFAC) Program report finds that for every dollar spent on health care-related fraud and abuse investigations over the last three years, the government recovered $8.10. This is the highest three-year average return on investment in the 17-year history of the HCFAC Program.

The report also shows that the government’s health care fraud prevention and enforcement efforts recovered a record-breaking $4.3 billion in taxpayer dollars in Fiscal Year (FY) 2013, up from $4.2 billion in FY 2012. These recoveries are from individuals and companies who attempted to defraud federal health programs serving seniors or who sought excessive or unlawful payments from taxpayers.

“The federal government has a duty to ensure that taxpayer dollars are being used lawfully, and that every available tool is being used to stop health care fraud across the country,” Wyden said. “These record-breaking recoveries certainly demonstrate a strong commitment to eliminating fraud, waste and abuse.”

Over the last four years, the Obama Administration’s enforcement efforts have recovered $19.2 billion, up from $9.4 billion over the prior five-year period. Since the inception of the program in 1997, the HCFAC Program has returned more than $25.9 billion to the Medicare Trust Funds and treasury.

This is the fifth consecutive year that the program has increased recoveries over the past year, climbing from $2 billion in FY 2008 to over $4 billion every year since FY 2011.

The success of this joint Department of Justice and Department of Health and Human Services effort was made possible in part by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in Medicare and Medicaid and to crack down on individuals and entities that are abusing the system and costing American taxpayers billions of dollars.

The new authorities under the Affordable Care Act granted to HHS and the Centers for Medicare & Medicaid Services (CMS) were instrumental in clamping down on fraudulent activity in health care. In FY 2013, CMS announced the first use of its temporary moratoria authority granted by the Affordable Care Act. The action stopped enrollment of new home health or ambulance enrollments in three fraud hot spots around the country, allowing CMS and its law enforcement partners to remove bad actors from the program while blocking provider entry or re-entry into these already over-supplied markets.

Building on this success, last month CMS announced an expansion of the provider moratoria to home health agencies in four additional cities and to ambulance providers in one additional city.